Health Professions Students’ Attitudes TowardTeamwork Before and After an Interprofessional

Education Co-Curricular Experience

Shelley C. Mishoe, PhD, FAARC, FASAHP; Kimberly Adams Tufts, ND, FAAN; Leigh Ann Diggs, PhD;

James D. Blando, PhD; Denise M. Claiborne, PhD; Johanna M. Hoch, PhD; Martha L. Walker, PhD

Old Dominion University

Abstract Background: Effective interprofessional collaboration may positively impact clin-ical outcomes, patient satisfaction, and cost effectiveness. However, educationalsilos and discipline-specific socialization have reinforced each health profession’sindependent values, attitudes, and problem-solving approaches.Methods and Findings: Students’ (N = 376) attitudes about teamwork were meas-ured with the Interprofessional Attitudes Scale, Teamwork, Roles, andResponsibilities subscale using a pretest-posttest design. Experiential learningstrategies and a case study approach were used to introduce students to the rolesand responsibilities of the students’ disciplines. ere was a positive mean differ-ence in pretest-posttest measures (p < .001) with a moderate effect size (r = .27).Conclusions: Providing opportunities for pre-licensure health sciences students tounderstand the roles and responsibilities of other disciplines through IPE co-cur-ricular learning can enhance positive attitudes toward teamwork.Keywords: Health sciences students; Interprofessional education; Teamwork;Roles and responsibilities; Co-curricular learning

Introduction

The importance of interprofessional teamwork has been recognized for more thanfour decades, but has only become a priority for education and practice in healthcarein recent years [1]. Educational traditions and specialization have prevented substan-tial progress in preparing health professionals with the attitudes and competenciesneeded for team-based care. Additional reports on safety [2], quality [3], interprofes-sional education (IPE) [4], and health outcomes [5] further emphasize the growingneed for teamwork and interprofessional collaborative practice (IPCP). Work oninterprofessional education and practice has occurred not only in the U.S., as pro-posed by the Institutes of Medicine (IOM), but also in Australia, Canada, Europe,New Zealand, the United Kingdom, and other countries with increasing global focus[6-11]. There is evidence that effective interprofessional healthcare teams may posi-tively impact clinical outcomes [12-14], increase patient safety [15-17], reduce med-ical errors [18,19], improve patient satisfaction [20], and achieve cost effectiveness

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doi: 10.22230/jripe.2018v8n1a264

Corresponding author:Shelley C. Mishoe. Email:smishoe@odu.edu

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[21-24]. Effective interprofessional teamwork in healthcare has also been associatedwith several positive employee outcomes, such as increased job satisfaction [25,26],lower stress [27], and higher staff retention [26,28-30].

Educational silos and discipline-specific socialization, as well as social, gender,and hierarchal issues, have reinforced the independent values, attitudes, language,and problem-solving approaches of each health profession, which presents manychallenges to effective interprofessional teamwork [31-33]. Healthcare systems havetraditionally valued expert status with the independent practice of health profession-als, resulting in a culture wherein individual, rather than collective, competence hasprevailed. Thus, health professionals have been ill-prepared for collaboration andoften compete instead of collaborate. Deficits in healthcare quality are often due toinadequate collaboration among members of interprofessional healthcare teams,along with gaps in constructive relationships among patients and providers [34]. Toeffectively engage in interprofessional collaborative practice that includes patientsand their families, healthcare professionals must be familiar with the expertise, roles,and responsibilities of various professionals and value shared decision-makingthrough authentic team-based care [29,35,36]. They must value interprofessionalpractice and be skilled in effective interprofessional communication [35].

To address the need for preparing health professionals with core competenciesfor IPCP, the dean of the College of Health Sciences (COHS) at a research-intensivepublic university formed an IPE taskforce to develop a college-wide proposal for cre-ating an IPE and collaborative practice culture post-graduation [35]. The IPE taskforce recommendations were implemented within one academic year and includedthe creation of a new administrative position , the assistant dean for IPE, and addi-tional budget for staff support, space, faculty professional development, student sup-port, co-curricular learning, course development, and non-personnel expenses. Astanding committee with representation from each of the five schools in the college,as well as student, community, and patient representatives, was formed to work withthe assistant dean for IPE to establish a process for designing, developing, and imple-menting IPE in the college [10,37]. Initial work included a survey of curricula acrossthe schools to identify courses that could support IPE, and the creation of additionalcurricular and co-curricular IPE learning experiences. This article reports on thefindings from a co-curricular learning experience designed to engage students fromdifferent health professions in interactive learning about each other’s professionalroles and responsibilities in order to enhance the students’ attitudes toward team-work and interprofessional collaborative practice. The specific aims of this studywere achieved; there was a significant increase in measures of teamwork followingan IPE learning experience.

Methods

Design

A pretest-posttest design was used to assess student attitudes about teamworkbefore and after participation in the interprofessional co-curricular learning experi-ence. The null hypothesis was that there were “no differences in students’ attitudes

about teamwork from participation in an IPE co-curricular experience.” The univer-sity’s Institutional Review Board approved all study-related procedures.

SampleA sample of students (N = 376) from the five schools of the College of Health Sciences,Community and Environmental Health, Dental Hygiene, Medical Diagnostics andTranslational Sciences, Nursing, and Physical Therapy and Athletic Training, partic-ipated in this study.

Procedures

An interprofessional approach was used to expose students from various health dis-ciplines to the scope of their own professional role and responsibilities as well as tothose of others. Faculty used experiential learning strategies and a case studyapproach to introduce students to the principles inherent in the InterprofessionalEducation Collaborative’s (IPEC) role and responsibilities competency. The pur-pose of the experience was to create a learning environment where students couldlearn about, with, and from each other in an environment devoid of the traditionaleducational silos that often inhibit interaction and collaboration among health pro-fessional students. The learning experience was part of a process within the collegeto facilitate the students’ achievement of the four IPEC competencies through cur-ricular and co-curricular strategies [35]. Upon registering, students were randomlyassigned to interprofessional groups and to five different session schedules. Studentsremained in these groups across a four-hour period: the introductory session, theexperiential learning sessions, and the debriefing session.

All students participated in a 30-minute kick-off session in which the principles ofIPE were introduced, the IPEC competencies were reviewed, the sequence of activitieswas detailed, and the purpose of the learning opportunity was emphasized. During thissession, students were asked to consider the case of a woman recently diagnosed withbladder cancer and undergoing chemotherapy treatment. The case was planned so thateach discipline could use a learning session to present information or activities relatedto how their various professions addressed the concerns of the same patient: throughlaboratory analysis and diagnostics, direct patient care following diagnosis, screeningfor cancer-associated oral health problems, rehabilitation post chemotherapy, or theimpact of environmental factors on the epidemiology of cancers (see Appendix A).

Students then travelled in their assigned interprofessional groups to each of thefive schools in the COHS, where they participated in sessions that highlighted thedisciplinary roles of various professions in relation to the case study. Five sessionstook place, with students moving in groups to a different session every 30 minutes.Students were able to learn about, with, and from each other through the sessionsand the case study, which focused on roles, responsibilities, and teamwork.

Students and faculty from each of the five schools of the COHS, who were trainedby college IPE staff prior to the event, led these sessions. Faculty facilitators, exceptfor the community member and some of those who assisted with the demonstra-tions, had also attended at least one of IPEC’s professional development institutes.

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The teaching-learning approach varied across the five schools, addressing profes-sional roles and responsibilities for the particular case study. Faculty from theSchool of Community and Environmental Health utilized a lecture to teach studentsabout the environmental risks that industrial hazards may pose to health and therole of industrial hygienists and environmental health professionals. In the Schoolof Dental Hygiene, participants visited the Dental Hygiene Clinic, where studentsdemonstrated how dental hygienists approach oral care and led a discussion aboutthe impact of chemotherapy on oral health. The School of Medical Diagnostics andTranslation Sciences used a lecture to highlight the role of cytotechnologists in diag-nosing bladder cancer and gave an interactive demonstration with teaching micro-scopes, which accommodated multiple learners to visualize the differences betweennormal and abnormal bladder cells. Nursing faculty and students used a simulationapproach to illustrate the nurse’s role in coordinating different aspects of healthcareand the tenets of patient advocacy. Athletic training and physical therapy studentstaught participants about the differences and commonalities of their respective rolesvia lecture, demonstrations, and an experiential balance assessment and rehabilita-tion exercise. Each session allotted time for questions, answers, and interaction.

A scavenger hunt that highlighted each discipline’s role took place as part of theeducational experience. This technique was designed to keep participants engaged,underscore that learning is fun, and set the stage for the debriefing session. Duringtravel time and in each session, the faculty facilitators encouraged continued inter-action about the various professional roles grounded within the case study. All stu-dent participants then returned to a common room where debriefing took place inthe form of a “student mixer.” Students were encouraged to reflect on their experi-ence. This was followed by a discussion of what was learned through the variousexperiential sessions. Prizes were awarded for the scavenger hunt activity. Theposttest took place after the completion of the debriefing sessions.

MeasuresDemographic data

All students were asked to complete a demographic form. The information collectedin this document included basic demographic information, such as program type,educational level, preliminary knowledge about the term IPE, and the number ofIPE events students had previously participated in.

Teamwork, roles, and responsibilities subscaleThe Interprofessional Attitudes Scale (IPAS) was developed as an outcome measureto assess all four IPEC competencies. The IPAS is a 27-item scale with five separatesubscales: Teamwork, Roles, and Responsibilities (TRR), Patient-Centeredness,Interprofessional Biases, Diversity and Ethics, and Community-Centeredness. Forthe purposes of this study, only the TRR portion of the IPAS was used. The TRR iscomprised of nine items scored on a five-point Likert scale, from strongly disagreeto strongly agree. The TRR questions are shown with the results. The TRR hasdemonstrated validity and internal consistency (α = 0.91) [38].

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Data management All survey data were assigned anonymous unique identifiers created by individualstudents. All data were checked for any personal identifiers and then de-identified.Paper questionnaires were kept in locked file cabinets in the IPE office of the COHS.Data from these questions were entered into the password-protected electronic data-base. The dependent variables were total scores on the TRR at pretest and posttest,and scores on each individual item. The independent variables were educationallevel (undergraduate or graduate), discipline (physical therapy, nursing, dentalhygiene, or other), and number of prior IPE experiences (none, one to two experi-ences, or more than two).

Data analyses Alpha was set a priori for all analyses, p < .05. All statistical analyses were performedin the Statistical Package for the Social Sciences (SPSS). Descriptive statistics wereused to describe the sample. Frequencies (number and percentage) were used todescribe the undergraduate and graduate students, the students by discipline, andany prior IPE participation. Cronbach’s alpha was used to determine internal con-sistency for both the TRR pretest and posttest. Non-parametric inferential statisticswere used to assess mean differences within subjects in the pretest and posttestscores on the TRR. The Wilcoxon Rank-Sum Test was also performed to discoverdifferences in the total teamwork scores by student discipline, number of prior IPEexperiences, and student educational level.

The Mann-Whitney U Test was used on the pretest and the posttest scores todetermine if there were any significant differences between subjects based on a stu-dent’s level of study or prior IPE experience. The Kruskal-Wallis Test was used todiscover any pretest and/or posttest differences in students’ perception of teamworkbased on their discipline or their prior IPE experience. Post hoc analyses were per-formed using the Mann-Whitney U with Bonferroni correction.

Results

There were 376 student participants.Students were enrolled in physical ther-apy (39.4%), dental hygiene (31.1%),nursing (21.3%), and other dsciplines(8.2%) including nuclear medicine,cytotechnology, athletic training, med-ical technology, and environmentalhealth programs. The majority of stu-dents had not previously participated inan IPE-learning activity (see Table 1).

The internal consistency of the TRRat pretest was acceptable (α = .65) and atposttest was good (α = .81). There was amean difference in pretest and posttest

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Characteristics N (%)

Student levelUndergraduateGraduate

220 (58.5%)156 (41.5%)

DisciplinePhysical therapyDental hygieneNursingOther

148 (39.4%)117 (31.1%)80 (21.3%)31 (8.2%)

Prior participation in IPE experiences None1–2> 2

255 (67.8%)103 (27.4%)18 (4.8%)

Table 1. Characteristics of studentsurvey respondents

TRR scores (p < .001), with significant differences found for each item and for theoverall score with a moderate effect size (r = .27) (see Table 2). Further analysesshowed significant differences in pretest and posttest scores for undergraduate stu-dents (p < .001) and graduate students (p < .001), and if the student had participatedin one to two prior IPE experiences (p < .05) or had no prior IPE experience (p <.001) (see Table 3). There were no significant differences between pretest andposttest scores (see Table 3) for students who had two or more prior IPE experiences(p = .082). There was a significant difference (p < .001) between pretest and posttestmeans, regardless if students were in the discipline of nursing, physical therapy, ordental hygiene (see Table 3). Due to the small sample sizes, statistical analyses werenot performed for the additional disciplines.

The Mann-Whitney U Test showed significant differences in the teamwork totalscores of undergraduate students (mean rank = 215.06) compared to graduate stu-dents pretest (mean rank 151.04, U = 11317.00, Z = -5.65, p < . 001, r = .29) and under-graduate students (mean rank = 192.72) compared to graduate students’ posttest(mean rank = 127.75, U = 8073.00, Z = -6.12, p < . 001, r = .32. The Kruskal-Wallistests also revealed differences based on students’ discipline in the pretest scores

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Question Pre median[IQR]

Post median[IQR]

Negativemean rank

Positivemean rank

Z* Asymp.sig. (2-tailed) p-value)**

1. Shared learning before graduation will help me become abetter team worker.

4 [4,5] 5 [4,5] 50.79 46.33 -6.322a < .001

2. Shared learning will help me think positively about otherprofessionals.

4 [4,5] 5 [4,5] 58.53 47.26 -6.016a < .001

3. Learning with other students will help me become a moreeffective member of the healthcare team.

4 [4,5] 5 [4,5] 49.63 44.77 -4.159a < .001

4. Shared learning with other health sciences students willincrease my ability to understand clinical problems.

4 [4,5] 5 [4,5] 48.61 42.34 -3.763a < .001

5. Patients will ultimately benefit if health sciences studentswork together to solve patient problems.

4 [4,5] 5 [4,5] 49.21 45.78 -2.429a < .05

6. Shared learning with other health sciences students will helpme communicate better with patients and other professionals.

4 [4,5] 5 [4,5] 48.75 45.01 -4.085a < .001

7. I would welcome the opportunity to work on small-groupprojects with other health sciences students.

4 [3,4] 4 [4,5] 73.97 70.20 -6.101a < .001

8. It is not necessary for health sciences students to learntogether.

2 [1,2] 2 [1,2] 62.63 91.92 -2.394b < .05

9. Shared learning will help me understand my own limita-tions.

4 [4,4] 4 [4,5] 62.48 58.74 -5.925a < .001

Teamwork Scale Total 35 [33,40] 38 [34,41] 92.34 136.27 -7.462a < .001

Table 2. Wilcoxon Rank Sum Test for pretest and posttest data comparison (N = 376)

Notes: a based on negative ranks (pretest < posttest); b based on positive ranks (posttest > pretest); * z is the number of standard deviations from the mean; **asymp. sig. is theasymptotic significance or p-value

(H (7) = 38.22, p < .001) and also in the posttest scores (H (7) = 42.41, p < .001). On thepretest, post hoc analysis found that dental hygiene students had significantly higherscores (mean rank = 161.30) than physical therapy students (mean rank = 110.63,U = 5347.00, Z = -5.37, p < .001, r = .33), and nursing students (mean rank = 140.13,U = 3870, Z = -4.33, p < .001, r = .29) had significantly higher scores than physical ther-apy students (mean rank = 100.65). All other comparisons were statistically non-sig-nificant. At posttest, post hoc analysis found that dental hygiene students also hadsignificantly higher scores (mean rank = 142.06) than physical therapy students’ scores(mean rank = 96.79, U = 4101.50, Z = -5.14, p < .001, r = .34). Additionally, nursingstudents’ scores on the posttest were significantly higher (mean rank = 130.79) thanphysical therapy students (mean rank = 84.37, p < .001, r = .39). All other comparisonswere statistically non-significant.

The Kruskal-Wallis tests also revealed differences in pretest scores (H (2) = 18.58,p < .01) andposttest scores (H (2) = 15.20, p < .01) based on the number of prior IPEexperiences. Post hoc analyses with Bonferroni correction confirmed that studentswith no prior IPE experience had significantly higher pretest scores (meanrank = 142.10) than those with three to four IPE experiences (mean rank = 64.69,U = 993.50, z = -4.0, p < .001, r = .24). Students who had one to two prior IPE experi-ences had significantly higher pretest scores (mean rank = 65.07) when compared tothose with three to four prior IPE experiences (mean rank = 37.69, U = 507.5, z = 3.07,p = .002, r = .28). The other comparisons were statistically non-significant.

Students with no prior IPE experiences had significantly higher posttest scores(mean rank = 166.87) than students with one to two IPE experiences (mean

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Table 3. Wilcoxon Signed Rank Test to compare pretest and posttest scores by student discipline, number of

IPE experiences, and student level

Variable Teamwork total Z* Asymp.sig. **(2-tailed) p-value

R***

Negativemean rank

Positivemean rank

Student educational levelUndergraduate (N = 156)Graduate (N = 220)

46.6843.75

79.8456.43

-6.6a

-3.7a< .001< .001

.31

.21

Number of Prior IPE ExperiencesNone (N = 255)1–2 (N = 103)3–4 (N = 18)

59.6427.434.50

96.9033.906.56

-7.0a

-2.4a

-1.7a

< .001< .05.082

.31

.17-

Student disciplinePhysical therapy (N = 148)Dental hygiene (N = 117)Nursing (N = 80)

41.5925.1818.80

54.6040.0030.85

-3.0a

-5.0a

-4.0a

< .001< .001< .001

.17

.33

.32

Notes: a based on negative ranks (pretest < posttest); * z is the number of standard deviations from the mean; **asymp. sig. is the asymptoticsignificance or p-value; ***r is the effect size

rank = 138.21, U = 8196.0, Z = -2.52, p = .01, r = .14) and students with no prior IPEexperiences had significantly higher posttest scores (mean rank = 126.73) than stu-dents with three to four IPE experiences (p = .001, r = .21).

Discussion

This study reports on a single co-curricular event within a broader college-wide IPEprocess. It demonstrates that IPE co-curricular learning focused on roles andresponsibilities can improve attitudes about teamwork and collaborative practiceregardless of a student’s program level, prior IPE experiences, or discipline. Thefindings are consistent with those reported in a comprehensive review of pre-licen-sure allied health curricula, suggesting that university-based IPE is feasible and effec-tive [39]. Several studies have examined health professions students’ acquisition ofIPE knowledge and skills, although fewer studies have examined the extent to whichIPE initiatives have changed the perceptions and values of health sciences students[40-42]. Studies have shown improvements in students’ perceptions of oneanother’s roles and responsibilities following IPE experiences, but not how learningabout the roles and responsibilities of other health professionals can impact atti-tudes toward teamwork [43-44].

Nursing, dental hygiene, physical therapy, and other allied health students in thisstudy had increased TRR scores for teamwork and collaboration following the IPEexperience, regardless of whether they were undergraduate or graduate students orif they had less than two prior IPE experiences. These findings are similar to othercase-based approaches, where interprofessional teams of students collaborated indecision-making and showed significant improvement in familiarity with the educa-tion and roles of each discipline, improvement in communication and teamworkskills, and improved team functioning [45,46]. These finding are important becausestudies suggest that baseline attitudes toward IPE have the strongest effect on atti-tudes toward IPE later in training [41] and can have lasting effects [47].

This study found that prior IPE learning affected students’ attitudes toward team-work. Students with no prior IPE experience or with one to two prior experienceshad significantly higher pretest scores than those with three to four IPE experiences.On the posttest, students with no prior IPE experiences also had significantly higherscores when compared to students with one to two IPE experiences and to studentswith three to four IPE experiences. The study also found that students with no priorIPE learning had a significant increase in overall teamwork scores and on each of thenine TRR questions. Students who had one to two prior IPE learning experiencesalso showed significant increase in their teamwork and collaboration scores; how-ever, not for every question. If students had more than two prior IPE experiences,there was no significant difference in their teamwork scores following the IPE learn-ing experience. It is possible that a difference was not found because of the smallsample size (n = 18) for this subset and the use of nonparametric statistics, whichhave insufficient power to identify a difference if one existed. However, others havereported that students who participated in interprofessional extracurricular activi-ties, especially patient-based activities, reported more positive attitudes in the third

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year than those who did not participate in such activities [41]. This suggests that stu-dents’ attitudes toward teamwork could be affected by prior IPE learning andshould be an important consideration when designing, implementing, and assessingco-curricular activities.

Although the results of this study show significant gains in TRR scores for allhealth sciences students, there were also some educational-level and disciplinary dif-ferences. Undergraduate students scored significantly higher on both the pretestand posttest compared to the graduate students. These findings are consistent withstudies suggesting that health profession students differ in their attitudes towardIPE based on discipline. This is also one of the first studies to include athletic train-ing, cytotechnology, dental hygiene, environmental health, and nuclear medicinetechnology students [39,48,49]. Other studies have reported on the limited involve-ment of dental hygienists in IPE and IPCP and the recognition that oral health pro-fessionals can be meaningful collaborators in interprofessional public healthservices [50]. Some studies have reported that characteristics associated with havinga more positive attitude about IPE at various points in time include being a nursingstudent, being female, and having more health experiences [39,41,51,52]. Perceiveddifferences in power and a poor IPE participation rate among some health profes-sions have also been reported [52-55]. These findings indicate that nursing and den-tal hygiene students had more positive attitudes about teamwork before and afterthe intervention. Although physical therapy students in this study had a significantincrease in their teamwork and collaboration scores following the IPE experience,the effect size was small, and further analysis show that their pretest scores andposttest scores were significantly lower than dental hygiene, nursing, and the otherhealth sciences students’ scores. This finding is consistent with other studies, whichhave shown that physical therapy and medical students have lower scores on meas-ures of teamwork and collaboration and value IPE and patient-centered learningless than other health professions and nursing students [41-43,52,53]. However,studies are increasingly showing positive faculty and student attitudes toward IPEfor these disciplines, and also that physicians, physical therapists, and others withadvanced or graduate degrees can have improved and lasting perceptions of team-work [56-60].

Nonetheless, there are many challenges to incorporating IPE into educationalprograms, such as schedule coordination, faculty development, curricula overload,resources, space, faculty engagement, clinical partnerships, and administrative sup-port [49,57,61-63]. This study demonstrates that co-curricular learning can addresssome of these barriers and facilitate students’ IPE competencies. Other major chal-lenges in the adoption of IPE and IPCP is the tendency to uphold traditional profes-sional boundaries rather than create and implement new team-based roles[52,63-66]. This study demonstrates how a team-based approach can overcome tra-ditional educational boundaries to provide students with IPE activities that can sig-nificantly increase their teamwork scores.

It is important that students’ curricula, including clinical experiences, reinforcestudents’ IPE competencies gained in an educational experience as described in this

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study. However, there are also many barriers to teamwork and collaborative practice,including preconceived stereotypes, relationships of power, and differing profes-sional cultures, which includes values, beliefs, attitudes, customs, language/jargon,and behaviours [31,32,54,67]. Health professionals enter their careers with specificexpertise in their own discipline and often lack a common understanding of theissues, values, and problem-solving approaches necessary to function effectively as ateam member. In addition to skill acquisition, it is important that IPE experiencespositively impact attitudes toward teamwork and collaborative practice, as demon-strated in this study. For collaborative practice, team members must understand oth-ers’ roles and responsibilities and assume joint responsibilities with patients and theirfamilies to achieve desired patient outcomes. Professional education programs needto facilitate interprofessional socialization (IPS) to prepare health professionals foreffective team-based care; however, IPS frameworks are limited [68,69].Collaboration between educational programs and healthcare providers are also nec-essary to create the types of authentic learning experiences needed to advance IPEand IPCP.

This study is limited by smaller sample sizes for some disciplines, data collectionat one institution only, and the lack of a control group. This limits its generalizabilityfor the development of the best IPE strategies to positively impact teamwork in prac-tice. This study suggests that an improved understanding of the roles and responsi-bilities of others can potentially explain the improvement in attitudes towardteamwork after training. Given the absence of a control group, this is only a tentativeexplanation that will require further investigation. Future research requires the long-term evaluation of interprofessional education and practice using quantitative andqualitative methods, with adequate funding for implementation, faculty committedto professional development, and researchers conducting more longitudinal follow-ups of learner and patient outcomes.

This study demonstrates that providing opportunities for pre-licensure studentsto understand the roles of other disciplines through interactive, co-curricular, case-based learning can enhance the positive attitudes toward teamwork that are impor-tant for interprofessional practice [7]. Students came together and began to fosterpositive relationships not based on professional rivalry, stereotypes, or power, buton mutual understanding and respect. Although this study demonstrates that a co-curricular IPE learning method generates positive results similar to those previouslyreported, it cannot be assumed that changes in attitudes will result in changes inbehaviour that lead to effective teamwork and improved patient outcomes [70].Additional research is needed to determine the lasting effects of positive changes inteamwork attitudes and whether attitudinal changes create actual behaviouralchanges and role changes as well as improvements in healthcare outcomes. Thisarea is ripe with opportunities for health services researchers [66,67,71]. A recentstudy found that when the contextual variables of IPCP were controlled by takinghealthcare professionals out of their normal work environments, few of the tradi-tional, stereotypical behavioural differences that have been attributed to the profes-sional groups were observed [72]. These findings are promising and suggest that

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contextual variables can remove barriers for IPE and IPCP. Perhaps future researchon IPCP should focus less on skills and attitudes of health professionals and moreon organizational and contextual variables that create or remove barriers.Furthermore, health professionals could benefit from IPE experiences that focusspecifically on teamwork interventions, and theoretical models of teamwork to notonly advance IPE research, but also contribute to improving healthcare outcomes[69,73-75].

Acknowledgements

The authors would like to thank the Dean’s Office in the College of Health Sciencesfor internally funding this study.

Abbreviations

College of Health Sciences (COHS)Interprofessional collaborative practice (IPCP)Interprofessional Attitudes Scale (IPAS)Interprofessional education (IPE)Interprofessional Education Collaborative (IPEC)Statistical Package for the Social Sciences (SPSS)Teamwork, Roles, and Responsibilities subscale (TRR)

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Appendix A

COHS Interprofessional EducationCase Study #1, Roles and Responsibilities

Mrs. Althea Gibson has received a diagnosis of bladder cancer. Mrs. Gibson is 45years old, is married, and has 3 children; 2 who are still at home. She was a collegeathlete and is still a “weekend warrior” who participates in marathons. She trains formarathons 5 days a week, does resistance training on 2 days, and loves Zumba. It isbelieved that her relative risk for developing bladder cancer may have been occupa-tional because she has worked in the textile industry for 20 years and was exposedto aniline dyes.

She was admitted to Monarch General for chemotherapy treatment. Potentialchemotherapy side effects include generalized gingival inflammation and xerosto-mia (dry mouth). It is expected that she may also become quite debilitated as a resultof the planned chemo and radiation therapy. Therefore, she will need extensivephysical rehabilitation. She has been referred to a rehabilitation service that special-izes in both physical therapy and athletic training.

The purpose of today’s College of Health Sciences Interprofessional Educationlearning activity is to enhance your knowledge of IPEC Competency #2, Roles andResponsibilities: using the knowledge of one’s own role and those of other profes-sions to appropriately assess and address the healthcare needs of the patients andpopulations served. An understanding of roles and responsibilities is an importantfirst step to working in interprofessional groups and ultimately to building well-functioning interprofessional teams and engage in effective teamwork (IPECCompetency #4, Teams and Teamwork).

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